by I Advance Senior Care A transformation
The Deupree House and Nursing Cottages, Cincinnati, Ohio
Tye Campbell, PE SFCS Inc.
Page 40
Simply put, The Deupree House and Nursing Cottages was one of the most challenging projects the SFCS Architects design team has ever worked on. Equal to the challenges it presented though, is the satisfaction received by the design team, staff, and residents in its completion.
The retirement community in Cincinnati, Ohio, owned by The Episcopal Retirement Homes of Ohio, underwent a comprehensive planning effort to revitalize its existing campus. By creating a new five-story, 60-unit, one- and two-bedroom state-of-the-art independent living apartment building with under-building parking, revenue was produced to support the campus upgrades and resort-style amenities. These amenities included renovated and expanded dining venues; a new community events center; a state- of-the-art wellness center, complete with a heated indoor pool and spa; exercise facilities; and chapel. In addition, to meet the health needs of the residents for a full continuum of care, two unique “nursing cottages” were added that look, feel, and operate like home. Each cottage has 10 private residential rooms with showers, and two private residential suites that allow for a separate living and sleeping area for total of 12 rooms. Common areas include the hearth room with fireplace, dining room, den, kitchen, spa, and library.
New construction comprised 190,984 sq. ft. and renovations covered 4,482 sq. ft.
Greatest challenge
SFCS worked closely with the City of Cincinnati Planning Commission and the Health Department throughout the design process to solve several challenges for the independent living apartments, wellness center, and the “cottage” additions. “We tackled each challenge one by one,” says Tye Campbell, PE, president of SFCS Architects of Roanoke, Virginia. For example, an existing easement for the extension of a future street (called a “paper street”) divided the Deupree Community, severely limiting the development potential of the site. Through negotiations with the city of Cincinnati, the paper street was permanently closed allowing for development of the property.
A major high-pressure gas line traversed through the property creating safety and maintenance challenges. The team also relocated a 54-in. combined sanitary sewer/storm line adjacent to the 20-in. high-pressure gas line (which supplies the upper northeast quadrant of Cincinnati) to allow adequate clearance to the proposed new community center and apartment building. By working around the gas line, the team was able to provide an extremely cost-effective solution, Campbell says. Future maintenance of the gas line and combined sewer was facilitated by incorporating a second floor pedestrian walkway, linking the new wellness center and existing campus to the new independent living building.
Additionally, the team faced neighborhood opposition to the proposed apartment building. Multimillion dollar homes look down from a well-established neighborhood directly onto the Deupree campus. The neighbors were concerned about the effect the removal of trees would have on their views, privacy, and real estate values. To minimize concern, the team developed a three dimensional, computer-generated site model to simulate views from each of the adjacent property owner's patios. “This neutralized the opposition,” Campbell reports. “No one showed opposition to our project during the final zoning meeting.”
Resident involvement
Resident involvement from the very beginning was essential to the project's success. “Episcopal Retirement Homes was adamant from day one that there be staff and resident involvement in the design,” Campbell says. Involvement began at the master planning stage and included design charettes with resident groups. Resident committees were formed and participated in “visual listening” exercises to help them explain to the design team what “home” meant to them and how to create a community that is meaningful to their generation. Residents participated and used inspirational photos from magazines to communicate and interpret aspects such as color and texture.
Campbell says the design team carefully listened to the answers the residents gave. Is “home” the color of the fence? Is it the material on the floors? Does seeing a hospital bed make it feel institutional? What evokes positive emotion and says “home” to the resident? “We gained new insights into the residents' view of their new community,” Campbell says. The design team applied the exercise to create an end product that matched the resident's vision of a home.
Construction of the new independent living apartments and wellness center took 18 months to complete. Construction of the nursing cottages took another 14 months.
The Deupree nursing cottages are unique with their two, 12- bed houses connected with a short, light-filled corridor. The South Cottage exterior is designed in the Craftsman style and the North Cottage is designed as a Colonial. Flexible workers prepare meals, create activities, plan daily life, and work as a team to be part of the home. A new culture, rooted in resident choice and resident involvement in directing their care and daily lives, has evolved and guides all aspects of the Deupree community.
Ideal working relationship
“It is very satisfying to work with a client who wants to push the envelope and create design that, at the end of the day, benefits the residents. It was the alignment of our firm's mission and the mission of Episcopal Retirement Homes in trying to create a design that ultimately makes the lives of staff and residents better that resulted in the successes we have seen and that the residents are reporting. Even though this was the hardest project I've ever worked on, we had fun,” Campbell says.
Campbell says Episcopal Retirement Homes' Laura Lamb, vice president of Residential Housing and Healthcare, was responsible for much of the project's success because of her commitment to the mission.
“Laura was the one in the trenches every day reminding the team of the end goal and was doing the hard work of keeping all the players organized,” Campbell says.
Because of visionary owners, staff, residents, and the design firm, the Deupree Campus was transformed from a dated apartment building for seniors with modest amenities to a state-of-the-art campus, according to Campbell. D
Tohono O'odham Assisted Living Elder Homes, Sells, Arizona
Thomas McQuillen, Principal Lizard Rock Designs, LLC
Page 42
When Lizard Rock Designs, LLC, first approached the design process for Tohono O'odham Assisted Living Elder Homes, it was literally unlike anything the company had experienced before. That's because the Tohono O'odham-meaning “desert people”-are more than a single client to deal with. They are a nation.
“Many tribes operate on a consensus basis,” says Lee Olitzky, who as the facility's representative to the Tohono O'odham tribal board worked with Lizard Rock Designs on the Sells, Arizona-based project. “What it means is you don't move forward or backward or sideways in something until everyone has had their chance to voice their opinion and impressions.”
Thomas McQuillen, principal of Lizard Rock Designs, admits there was a significant learning curve involved in the process (which itself ended up being beneficial as he has gained listening skills that proved useful on other projects).
“When you're up in front of a client, the worst thing is to have silence,” McQuillen explains. “And a lot of times, Lee had to coach us to be quiet, and let everyone on the board express their opinions. We, as designers, interpret it as, ‘Oh, they don't like what we've come up with.’ But that wasn't what was happening.”
After the ice was broken with the tribal board's methods, McQuillen had a much larger obstacle to overcome. Given the massive rural locations that Native Americans inhabit, senior living has often been a disappointment for those elders who must move to distant cities after being outdoors their entire lives.
To ensure the Tohono O'odham, who don't isolate their elders, can interact with the residents without much travel, the Assisted Living Elder Homes are being built in a central location surrounded by many scattered villages of 50-75 people. Major community events will be held in the facility's oversized parking lots where tents can be set up for cookouts and other celebrations. The idea is that if the elders can't come to the villages, the villages will come to the elders.
The design of the facility is also opened up to allow for more than 180-degree views of the surrounding desert and mountain ranges, which are of significant importance to the Tohono O'odham.
“Their expectation is to spend as little time inside the house and as much time as possible outside the house,” Olitzky says. “These buildings are clustered with areas for residents to walk into the desert. Even the nursing home, which is adjacent to the assisted living property, note that their elders would literally walk 20 to 30 minutes into what we would think is the middle of nowhere in the desert, but it's what they are accustomed to.”
div class=”caption”>Lee Olitzky
McQuillen says this project opened his eyes to not only the lives of the Tohono O'odham elderly, but also to the creativity that can be achieved when working outside his normal parameters.
“I was truly there to listen and respond to what they voiced they were trying to achieve,” he says. “I think that the surprising thing is that the result is more innovative than if we came into it and said, ‘OK, we're going to take all of our expertise and do the most cutting-edge thing we can think of.’ By not bringing preconceptions into it, we ended up with something that was more innovative than it would have been.” D
The Cascades Verdae, Greenville, South Carolina
William P. Steele, Jr., AIA, Principal Calloway Johnson Moore & West (CJMW)
Page 44
Aging is not a static proposition. It incorporates many phases from retirement to active living to possibly requiring assistance, and beyond. Keeping people at the independent end of the time line requires planning and creativity not only in programming but in environments. Banyan Senior Living, an owner/operator of long-term care facilities, chose to build its centerpiece CCRC community-The Cascades-in Verdae, a mixed-use development in Greenville, South Carolina. This community is a culmination of all that Banyan has learned in managing and operating facilities in its 18-year history. “Not only does Banyan run a first-rate campus inside and out, but they offer their residents first-rate service and care as well,” says William P. Steele, Jr., AIA, principal at CJMW, the project's architects.
To blend the best features into one exemplary campus took a lot of planning and input from residents and staff at all levels. “Because this is home to some and a place of employment for others, it was important that the project meet their needs and expectations,” explains Steele. “What good is a beautiful building that doesn't make its residents feel at home or provide ways for staff to do their jobs better and more efficiently,” he adds.
The Cascades Verdae is a for-profit organization. However, to be a success it has to be attractive for residents and make good business sense. Banyan wanted all residents to feel part of the community-whether they lived independently or required skilled care. “To bring that sense of unification,” says Steele, “the environment in the licensed skilled nursing healthcare facility was designed to keep those residents on an equal status with the rest of the CCRC.” There was no drop off in the quality of architecture or detail among the levels of care. “The physical environments of each level of care have the same kinds of things that make a place a home, such as generous use of wood molding and comfortable finishes and furniture in familiar spaces,” Steele comments. Whether residing in independent living, assisted living, or in a household in the healthcare center, the detail, space perception, and feeling of home is there.
Of course, the state regulators had to interpret guidelines for the architects to implement some of their concepts. Steele cites how they had to negotiate to obtain waivers. “In assisted living we have four households and wanted to install a residential kitchen in each. To be able to have an open floor plan, we used a residential range hood but had to install a commercial fire suppression system in it. It was invisible to anyone, so it was a great solution to a problem,” he says.
The Clubhouse is the focal point of the community. It is a 50,000-sq.-ft. building that is directly connected to the healthcare center. By using a series of “connectors,” residents can use these indoor routes to access the fitness center, dining venues, and a ballroom without having to go outdoors. “Not only is this convenient, but it encourages all residents, those in healthcare as well as in independent living, to take advantage of the programs offered and the opportunities to make friends,” Steele explains.
“I've talked with dozens of residents about their perceptions of the whole campus and they say that it's like no other place they've been.” Steele concludes by recognizing that through design, attention to detail-both physical and emotional-Cascades Verdae has met its objective of promoting the health, wellness, and independence of its community members. D
Walnut Village, Anaheim, California
Mark Seres, President-Creative Director CastleRock Design Group, Inc.
Page 46
Situated in Southern California's exciting city of Anaheim, the residents of Walnut Village, a 12-acre gated continuing care retirement community, can continue living a vibrant lifestyle enjoying the security and peace of mind that 21st-century community living can provide. In addition to the many on-campus shops, restaurants, and fitness and cultural opportunities, residents also have easy access to world-famous attractions, such as Disneyland, local museums, and Angel Stadium. Upscale in design and services, Walnut Village is a benchmark senior community.
Owned and operated by Front Porch Communities and Services, Walnut Village is designed with a “small town” feel, featuring a village square. There, residents have an array of dining venues, social activities, shops, and other diversions to enjoy. Its campus boasts the benefits of a Fitness and Aquatics Center, a Lifelong Learning Center, and a Performing Arts Center.
“One of the biggest challenges in constructing this new community involved the existing independent/assisted living (IL/AL) structures that were attached to services at the adjacent skilled nursing facility. The IL/AL building had to be demolished without disrupting service to the care center residents,” says Mark Seres, president and creative director of CastleRock Design Group. This obstacle was overcome by locating the shared utilities between the buildings, isolated, and dealt with on an individual basis. When necessary, temporary utility feeds and a mobile kitchen were provided to maintain constant service to the care center. Eventually, all these challenges were expediently resolved to regulators' and owners' satisfaction.
Universal design principles and state-of-the art technology are evident throughout the village. Residences were designed to be adaptable to a resident's changing needs. Door and counters can accommodate wheelchairs and each residence has a large walk-in shower. The entire village utilizes wireless monitoring systems to provide safety-inside and out. A programmable key-fob device allows residents to access their homes or apartments and certain other predetermined doors around campus.
There has been exceptional attention to detail in this community-from art-filled rooms to the detail in design and décor throughout all levels of care and amenities, such as the colorful mobile suspended above the pool in the Aquatics Center.
This is a warm, inviting community. In addition to the village center, serenity gardens, ornamental trees, and a water feature provide a peaceful area where residents can visit, read, or relax and just enjoy the California sunshine. And at the southern end of the village is a lush putting green and an outdoor dining area. The residences connect seamlessly to the outdoor spaces. This open design promotes a sense of connection and communication among residents and staff.
Walnut Village is the embodiment of today's retirement perspective: self-determination, choice, and the continuation of lifelong learning and pursuits. New friendships and positive attitudes among residents, staff, and visitors attest to the success of this community. D
La Siena Senior Living, Phoenix, Arizona
LuAnn Thoma-Holec, ASID Thoma-Holec Design LLC
Page 48
Not too long ago, LuAnn Thoma-Holec was touring the 190-unit La Siena Senior Living community with some of her relatives from Wisconsin. As is part of her habit as a designer-always returning at least once to the facilities she helped form-the owner of Thoma-Holec Design LLC, was greeting residents while also acting as a guide for her family. After all, as Thoma-Holec says, “They understand that I am a designer and everyone thinks that designers decorate, so I really wanted to show them something.”
As their visit ended, Thoma-Holec recalls, they passed the front reception desk when a gentleman in a scooter approached her 87-year-old aunt, who was already in awe of the community's sociable environment.
“Are you going to move in?” the resident asked.
“No, I live in Wisconsin, I can't move here,” Thoma-Holec's aunt responded.
“Oh, you should. It's the most wonderful place that I've ever lived.”
“Well, my niece here designed it,” her aunt said, introducing him to LuAnn. The energized resident then eagerly told of his favorite places within La Siena, remarking about how homelike it is and assuring them that he had made friends and never felt alone.
“As I was walking out the door, one of my cousins said, ‘Well that's better than any award you could ever get,’” Thoma-Holec says fondly. “It's nice to get the awards, but when you see the residents using the space and being happy, that's what is important.”
Behind her award-winning design-which has been honored numerous times for hospitality and senior care excellence by the American Society of Interior Designers-is the belief in creating “destinations within the building” that drive resident socialization. Take for example La Siena's classic movie theater, complete with floor-fastened theater seats, surround sound, and screen. Thoma-Holec says when the theater is not being used for films, the screen retracts, revealing a 50-inch plasma television. Residents will congregate to watch news, sports, or each other as they play Nintendo Wii bowling in the central aisle.
Other destinations include a bistro, wellness area, and pub with extensive gaming options. The Tuscan look of key areas, such as the lobby, also contributes to the “upscale, elegant, resort feel” of La Siena that Thoma-Holec envisioned. “If residents are unable to drive or don't have family members that can come visit regularly or they don't have as many social opportunities to leave the building, if we create a destination within, it makes residents feel like they're actually going somewhere,” she explains.
Thoma-Holec's focus on encouraging socialization in senior living came from watching her mother move into a community at a fairly young age. Although she was physically active, her mother had “issues” in needing to stay busy and be around people.
“I always keep that in the back of my mind that people need to have a purpose,” Thoma-Holec says. “They need to be able to have friends and activities and have opportunities where they can learn and grow and experience no matter what age they are.”
And if any visitor is skeptical that Thoma-Holec was successful in her work at La Siena, they should seek out the radiant gentleman in the scooter-if he hasn't found them already. D
Edgewater, West Des Moines, Iowa
Gene Guszkowski, AIA, Principal AG Architecture, Inc.
Page 50
A perfect melding of the owner and architect's resident-centered design philosophies resulted in an innovative solution at Edgewater in West Des Moines, Iowa. The 15,800-sq.-ft. skilled nursing component of the $58 million continuing care retirement community was singled out by jurors as a DESIGN Citation winner.
Skilled nursing at Edgewater is comprised of four, 10-bed “service households” which convey a sense of home and intimacy while being served by service areas that are centralized to support staff efficiencies. Each household features a different color scheme and has different art to allow for easier wayfinding. Edgewater also includes 137 independent living apartments, 32 assisted living units, 16 memory care units, and seven duplex cottages besides the 40 skilled nursing beds.
Says project architect Gene Guszkowski, AIA, principal, AG Architecture, Inc., “You get great projects because of great clients. In this case, WesleyLife pushed us to deliver the resident-centered facility they envisioned.”
Each of the four service households (similar to a Green House®) has its own distinct entrance and was designed with numerous common spaces to encourage interaction between staff and residents. Spaces such as a family room, great room, library, dining area, kitchen, and sunporch provide residents the opportunity to move beyond the confines of their bedroom to experience a sense of community. Residents are free to travel from space to space with visual and physical access to outdoor views and controlled outdoor areas as well as ample natural light just as they would have in their own home. “What I'm most proud of in this project is that we were able to accomplish the feel of a Green House and still get some very efficient interconnectivity between the four houses,” Guszkowski says. Two households share one food service pantry. Then, physical therapy, beauty/barber, a wellness center, spa, laundry room, and fully equipped kitchen facility are easily accessible by all four households without the need for disruptive traffic within the individual residential environments. Private rooms provide residents the opportunity to personalize their own living space and express their individuality. Each room has large windows with views of the landscape.
“The design supports resident self-determination and choice, creates a warm and inviting environment and facilitates efficient service delivery,” Guszkowski says.
The project did come up against some state and local code restrictions it could not overcome. WesleyLife wanted to incorporate cooking capabilities within each household, but despite discussions in favor of this cutting-edge design philosophy, state restrictions prohibited the design of fully functioning kitchens accessible to residents. The initial reaction was to create “activity kitchens” alongside dining areas which were placed adjacent to a fully equipped commercial-grade serving kitchen shared by two households. In practice however, the staff has, in fact, used these activity kitchens in the true spirit in which they were designed and a portion of the actual daily food preparation is done in these areas. The end result is an environment that functions in a similar manner to a residential kitchen and adjacent dining space as found in single-family homes.
“The family is encouraged to do cooking there when they come to visit,” Guszkowski says. “Maybe they want to make mom's favorite cookie or a cheesecake.”
Besides the kitchen restrictions, the design team, including Russ McLaughlin, AIA, senior living specialist; Joe Silvers, AIA, senior associate; and project manager Dave Trinkner, faced obstacles in the resident bathroom design, says McLaughlin. “The team wanted to incorporate swing-up grab bars to better suit the needs of the residents and to allow the staff to more efficiently assist them in the bathroom. However, the state of Iowa codes prevented the integration of this specification,” he says. As a result, the team had to use the standard ADA-compliant grab bars and fully handicap-accessible showers with a fold-down seat.
“What I'm most proud of in this project is that we were able to accomplish the feel of a Green House and still get some very efficient interconnectivity between the four houses,” Guszkowski says. The firm has had other projects in which it tried to build the Green House model of individual cottages, but had issues with FTEs, according to McLaughlin. “I think Edgewater's solution is one way to address those issues,” he says.
Silvers also says Edgewater was a fun place to visit after construction to hear all the positive comments from the residents. “I had residents come up to me and say how much they enjoy the facility, like living there, and that Edgewater was everything they imagined,” he says.
The total project took five years to complete.
“I think the industry is looking for a new paradigm for the continuing care retirement community,” Guszkowski explains. “CCRCs in the past have been patterned after resort hotels. I think Edgewater, as a whole, represents a completely different approach, much like a town center. WesleyLife wanted a 24/7 feel to Edgewater. This resident-centered solution focuses on that.” D
Jury comments:
Norwood Crossing
Hanna Z Interiors Ltd.
“Bathing area has a very comfortable feel, noninstitutional.”
NewBridge on the Charles
Perkins Eastman
“Resident rooms and corridor wrap around a central kitchen.”
Menorah Hospice
The Geddis Partnership, A Professional Corporation
“Accommodating family is at the core of this design – good!”
Southminster
FreemanWhite
“Stepping down the building to reduce its mass.”
Casitas on East Broadway
Lizard Rock Designs, LLC
“Pathway running length of, and between, the buildings creates a nice way for residents to naturally interact as they move about the property.”
7500 York Cooperative
Mohagen/Hansen Architectural Group
“Dramatic update and upgrade of interiors on a limited budget.”
Pines Village Retirement Communities
Community Living Solutions, LLC
“Independent Living hallway has enhancements that create a residential look and go a long way in breaking up the length. Millwork enhances the apartment doorways in a way that really creates a ‘you have arrived’ residential feel.”
Sagewood
Todd & Associates, Inc.
“Great, inviting and innovative outdoor space.”
To send your comments to the editor, e-mail mhrehocik@iadvanceseniorcare.com.
Design Environments for Aging 2010 2010 March;():32-39
I Advance Senior Care is the industry-leading source for practical, in-depth, business-building, and resident care information for owners, executives, administrators, and directors of nursing at assisted living communities, skilled nursing facilities, post-acute facilities, and continuing care retirement communities. The I Advance Senior Care editorial team and industry experts provide market analysis, strategic direction, policy commentary, clinical best-practices, business management, and technology breakthroughs.
I Advance Senior Care is part of the Institute for the Advancement of Senior Care and published by Plain-English Health Care.
